Obstructive uropathy due to prolapsed lower ureters and bladder in patients with severe procidentia: A report of two cases

Abstract

INTRODUCTIONPelvic organ prolape is not uncommon in multi-parous or elderly women. It is one of the rare but important causes of obstructive uropathy. Herein, we report two cases of severe procidentia that were referred with obstructive uropathy due to prolapsed bladder and ureters. PRESENTATION OF CASEThe first case was a 78-year-old woman, with severe pelvic organ prolape and secondary bilateral hydroureteronephrosis and post-renal failure. She was treated successfully by bilateral nephrostomy insertion and then pessary insertion. The second case was a 75-year-old woman who referred with the same presentation, but treated surgically with burch colposuspention and synchronous bilateral ureteral stent insertion. DISCUSSIONPelvic organ prolapse is not uncommon in old women. In addition to physical problems of procidentia, it may cause acute renal failure (ARF), chronic renal failure (CRF), and finally end stage renal disease (ESRD) if undiagnosed. CONCLUSIONIn every aged female case with obstructive uropathy and/or bilateral hydroureteronephrosis with unknown causes, gynecologic examination should be performed for early detection of possible pelvic organ prolapse. Appropriate management is necessary to prevent renal failure from uterine prolapse (UP).